Advertisement

Athletic Injuries Involving the Hip

  • Justin Roth
  • Jeffrey J. NeppleEmail author
Chapter

Abstract

Hip pain in the adolescent patient can be due to a variety of factors, including acute injury or chronic overuse. The current chapter will cover four common causes of pain in this population. Pelvic apophysitis commonly occurs as a chronic overuse injury resulting from overload of these pelvic growth centers. Pelvic avulsion fractures are among the most common acute injuries in this population and generally are treated with conservative methods. Athletic pubalgia, or sports hernia, occurs less commonly in the adolescent compared to adults, and is a chronic overuse condition of the abdominal wall. Acetabular labral tears are the most common surgically treated injury in the adolescent patient and generally occur as the result of underlying bony deformity including femoroacetabular impingement (FAI) or acetabular dysplasia. The current chapter will cover these injuries and their arthroscopic treatment, while FAI and acetabular dysplasia are covered in separate chapters.

Keywords

Pelvic avulsion fracture Pelvic apophysitis Athletic pubalgia Labral tear 

References

  1. 1.
    White KK, Williams SK, Mubarak SJ. Definition of two types of anterior superior iliac spine avulsion fractures. J Pediatr Orthop. 2002;22(5):578–82.PubMedGoogle Scholar
  2. 2.
    Parvaresh KC, Upasani VV, Bomar JD, Pennock AT. Secondary Ossification Center appearance and closure in the pelvis and proximal femur. J Pediatr Orthop. 2018;38(8):418–23.CrossRefGoogle Scholar
  3. 3.
    Schuett DJ, Bomar JD, Pennock AT. Pelvic apophyseal avulsion fractures: a retrospective review of 228 cases. J Pediatr Orthop. 2015;35(6):617–23.CrossRefGoogle Scholar
  4. 4.
    Eberbach H, Hohloch L, Feucht MJ, et al. Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports. BMC Musculoskelet Disord. 2017;18(1):162.CrossRefGoogle Scholar
  5. 5.
    Irving MH. Exostosis formation after traumatic avulsion of the anterior inferior iliac spine. Report of two cases. J Bone Joint Surg Br. 1964;46:720–2.CrossRefGoogle Scholar
  6. 6.
    Howard FM, Piha RJ. Fractures of the apophyses in adolescent athletes. JAMA. 1965;192:842–4.CrossRefGoogle Scholar
  7. 7.
    Servant CT, Jones CB. Displaced avulsion of the ischial apophysis: a hamstring injury requiring internal fixation. Br J Sports Med. 1998;32(3):255–7.CrossRefGoogle Scholar
  8. 8.
    Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skelet Radiol. 2001;30(3):127–31.CrossRefGoogle Scholar
  9. 9.
    Hosalkar HS, Pennock AT, Zaps D, et al. The hip antero-superior labral tear with avulsion of rectus femoris (HALTAR) lesion: does the SLAP equivalent in the hip exist? Hip Int. 2012;22(4):391–6.CrossRefGoogle Scholar
  10. 10.
    Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112–20.Google Scholar
  11. 11.
    Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011;27(12):1732–7.CrossRefGoogle Scholar
  12. 12.
    Wagner S, Hofstetter W, Chiquet M, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthr Cartil. 2003;11(7):508–18.CrossRefGoogle Scholar
  13. 13.
    Matsuda DK, Calipusan CP. Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics. 2012;35(3):e460–3.PubMedGoogle Scholar
  14. 14.
    Sundar M, Carty H. Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome. Skelet Radiol. 1994;23(2):85–90.CrossRefGoogle Scholar
  15. 15.
    Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT. Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res. 2013;471(8):2497–503.CrossRefGoogle Scholar
  16. 16.
    de Sa D, Alradwan H, Cargnelli S, et al. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy. 2014;30(8):1026–41.CrossRefGoogle Scholar
  17. 17.
    Gidwani S, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents--an easily missed diagnosis. BMJ. 2004;329(7457):99–100.CrossRefGoogle Scholar
  18. 18.
    Feucht MJ, Plath JE, Seppel G, et al. Gross anatomical and dimensional characteristics of the proximal hamstring origin. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2576–82.CrossRefGoogle Scholar
  19. 19.
    Moatshe G, Chahla J, Vap AR, et al. Repair of proximal hamstring tears: a surgical technique. Arthrosc Tech. 2017;6(2):e311–7.CrossRefGoogle Scholar
  20. 20.
    Hamming MG, Philippon MJ, Rasmussen MT, et al. Structural properties of the intact proximal hamstring origin and evaluation of varying avulsion repair techniques: an in vitro biomechanical analysis. Am J Sports Med. 2015;43(3):721–8.CrossRefGoogle Scholar
  21. 21.
    Ferlic PW, Sadoghi P, Singer G, Kraus T, Eberl R. Treatment for ischial tuberosity avulsion fractures in adolescent athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):893–7.CrossRefGoogle Scholar
  22. 22.
    Linni K, Mayr J, Hollwarth ME. Apophyseal fractures of the pelvis and trochanter minor in 20 adolescents and 2 young children. Unfallchirurg. 2000;103(11):961–4.CrossRefGoogle Scholar
  23. 23.
    Willinger L, Schanda JE, Lorenz S, Imhoff AB, Buchmann S. Surgical treatment of two adolescent athletes with dislocated avulsion fracture of the anterior superior iliac spine (ASIS). Arch Orthop Trauma Surg. 2017;137(2):173–7.CrossRefGoogle Scholar
  24. 24.
    Li X, Xu S, Lin X, Wang Q, Pan J. Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents. Injury. 2014;45(4):721–4.CrossRefGoogle Scholar
  25. 25.
    Meyers WC, Havens BK, Horner GJ. Core muscle injury (a better name than “athletic pubalgia” or “sports hernia”). Current Orthopaedic Practice. 2014;25(4):321–6.CrossRefGoogle Scholar
  26. 26.
    Taylor DC, Meyers WC, Moylan JA, et al. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia. Am J Sports Med. 1991;19(3):239–42.CrossRefGoogle Scholar
  27. 27.
    Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (performing athletes with abdominal or inguinal neuromuscular pain study group). Am J Sports Med. 2000;28(1):2–8.CrossRefGoogle Scholar
  28. 28.
    Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy. 2011;27(6):768–75.CrossRefGoogle Scholar
  29. 29.
    Brunt LM. Hernia management in the athlete. Adv Surg. 2016;50(1):187–202.CrossRefGoogle Scholar
  30. 30.
    Gamble JG, Simmons SC, Freedman M. The symphysis pubis. Anatomic and pathologic considerations. Clin Orthop Relat Res. 1986;(203):261–72.Google Scholar
  31. 31.
    Feeley BT, Powell JW, Muller MS, et al. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008;36(11):2187–95.CrossRefGoogle Scholar
  32. 32.
    Mullens FE, Zoga AC, Morrison WB, Meyers WC. Review of MRI technique and imaging findings in athletic pubalgia and the "sports hernia". Eur J Radiol. 2012;81(12):3780–92.CrossRefGoogle Scholar
  33. 33.
    Birmingham P, Larson CM. Medial soft tissue injuries of the hip: adductor strains and athletic pubalgia. In: Kelly BT, Larson CM, Bedi A, editors. Hip injuries: diagnosis and management. New Jersey: SLACK Inc; 2012.Google Scholar
  34. 34.
    Minnich JM, Hanks JB, Muschaweck U, Brunt LM, Diduch DR. Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique. Am J Sports Med. 2011;39(6):1341–9.CrossRefGoogle Scholar
  35. 35.
    Meyers WC, McKechnie A, Philippon MJ, et al. Experience with "sports hernia" spanning two decades. Ann Surg. 2008;248(4):656–65.PubMedGoogle Scholar
  36. 36.
    Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998;17(4):787–93.. viiCrossRefGoogle Scholar
  37. 37.
    Irshad K, Feldman LS, Lavoie C, et al. Operative management of "hockey groin syndrome": 12 years of experience in National Hockey League players. Surgery. 2001;130(4):759–64; discussion 764-756CrossRefGoogle Scholar
  38. 38.
    Knapik DM, Gebhart JJ, Nho SJ, et al. Prevalence of surgical repair for athletic pubalgia and impact on performance in football athletes participating in the National Football League Combine. Arthroscopy. 2017;33(5):1044–9.CrossRefGoogle Scholar
  39. 39.
    Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005;8(1):77–84.CrossRefGoogle Scholar
  40. 40.
    Farber AJ, Wilckens JH. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15(8):507–14.CrossRefGoogle Scholar
  41. 41.
    Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med. 2000;28(3):350–5.CrossRefGoogle Scholar
  42. 42.
    Zoga AC, Kavanagh EC, Omar IM, et al. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 2008;247(3):797–807.CrossRefGoogle Scholar
  43. 43.
    Slavotinek JP, Verrall GM, Fon GT, Sage MR. Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome. Am J Sports Med. 2005;33(6):894–9.CrossRefGoogle Scholar
  44. 44.
    Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.CrossRefGoogle Scholar
  45. 45.
    Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29(1):46–53.CrossRefGoogle Scholar
  46. 46.
    Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40(5):1015–21.CrossRefGoogle Scholar
  47. 47.
    Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.1):36–53.CrossRefGoogle Scholar
  48. 48.
    Bharam S. Labral tears, extra-articular injuries, and hip arthroscopy in the athlete. Clin Sports Med. 2006;25(2):279–92.. ixCrossRefGoogle Scholar
  49. 49.
    Konrath GA, Hamel AJ, Olson SA, Bay B, Sharkey NA. The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip. J Bone Joint Surg Am. 1998;80(12):1781–8.CrossRefGoogle Scholar
  50. 50.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15(6):463–8.CrossRefGoogle Scholar
  51. 51.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36(2):171–8.CrossRefGoogle Scholar
  52. 52.
    Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal--part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):730–6.CrossRefGoogle Scholar
  53. 53.
    Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal--part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):722–9.CrossRefGoogle Scholar
  54. 54.
    Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40.CrossRefGoogle Scholar
  55. 55.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8.CrossRefGoogle Scholar
  56. 56.
    Ross JR, Zaltz I, Nepple JJ, Schoenecker PL, Clohisy JC. Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med. 2011;39(Suppl):72s–8s.CrossRefGoogle Scholar
  57. 57.
    Larson CM, Clohisy JC, Beaule PE, et al. Intraoperative and early postoperative complications after hip arthroscopic surgery: a prospective multicenter trial utilizing a validated grading scheme. Am J Sports Med. 2016;44(9):2292–8.CrossRefGoogle Scholar
  58. 58.
    Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986;68(3):400–3.CrossRefGoogle Scholar
  59. 59.
    Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73(3):423–9.CrossRefGoogle Scholar
  60. 60.
    Lage LA, Patel JV, Villar RN. The acetabular labral tear: an arthroscopic classification. Arthroscopy. 1996;12(3):269–72.CrossRefGoogle Scholar
  61. 61.
    Fitzgerald RH Jr. Acetabular labrum tears. diagnosis and treatment. Clin Orthop Relat Res. 1995;(311):60–8.Google Scholar
  62. 62.
    Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy. 2007;23(4):376–80.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryWashington University School of MedicineSt. LouisUSA

Personalised recommendations